Transcript Medicines Use Review Conducted in Community Pharmacy

“Medicines use review conducted
in community pharmacy"
Professor Ian Chi Kei Wong
Department of Health Public Health Career Scientist
The School of Pharmacy
University of London
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• The National Health Service (NHS) is a
state-funded healthcare delivery model.
• Traditionally prescribing and dispensing
are separate:
– Medical practitioners are prescribers
– Pharmacists are medications providers
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Medical and Pharmaceutical
Services
• Primary care medical services are
provided by General Practice
– Also employ other health professionals such
as practice nurses and practice pharmacists
• Primary care pharmaceutical services are
provided by community (retail) pharmacies
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Community pharmacy
• Community pharmacies
are not employees of the
NHS
• Contractors
• On average each
pharmacy provides 100
hours per week service
to the NHS
• 80% of income come
from the NHS, mostly
from dispensing.
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Recognitions
• Government has recognised the skills of
community pharmacists.
• Community pharmacists have taken on
extra roles (enhanced services)
– Smoking cessation
– Supervised administration of methadone
– Medicines Use Review (MUR)
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Medicines Use Review
• This service includes medicines use
reviews undertaken periodically, as well as
those arising in response to the need to
make a significant prescription intervention
during the dispensing process.
• Medicines use review is about helping
patients use their medicines more
effectively.
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Aims of Medicines Use Review
To improve patient knowledge, concordance and
use of medicines by:
• establishing the patient’s actual use,
understanding and experience of taking their
medicines
• identifying, discussing and resolving poor or
ineffective use of their medicines
• identifying side effects and drug interactions that
may affect patient compliance
• improving the clinical and cost effectiveness of
prescribed medicines and reducing medicine
wastage
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Where to conduct?
• Should normally be carried out face to
face
– community pharmacy
– patients’ homes or
– day care centres
• Only when it is not practical
– conducted by telephone
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Requirements
• The consultation area should be clearly
designated as an area for confidential
consultations.
• Pharmacists providing the service should
have passed an assessment, based on
the nationally agreed competencies for the
service.
• Courses are available from different
universities.
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Interventions
• Advice on medicines usage (prescribed and
OTC) to improve concordance
• Effective use of ‘when required’ medication
• Ensuring appropriate use of different medicine
dosage forms e.g. inhaler technique
• Advice on tolerability and side effects
• Dealing with practical problems in ordering,
obtaining, taking and using medicines
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Interventions
• Highlighting the following issues to the
prescriber by identifying and/or
suggesting:
– Medication with inadequate dosage
instructions or dose optimisation
– Unwanted medicines
– A change of dosage form to facilitate effective
usage;
– Appropriate generic or branded products
which suit the patient
– Other appropriate interventions agreed locally
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Record keeping
• A record of the medicines use review
should be made on the patient’s pharmacy
record.
• A summary of the medicines use review
and any recommendations should be sent
to the patient’s GP, using the nationally
agreed recording template.
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Record keeping
• A copy of the medicines use review
summary and recommendations should be
given to the patient.
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Roles of clinician, pharmacist and patient in
Pharmaceutical care
Improve patient's QOL
Patient
Communication & Agreement
Communication & Agreement
Pharmaceutical
Care Plans
Pharmacist
Clinician
Communication & Agreement
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Roles of clinician, pharmacist and patient in
medicines use review
Safe and effective use of
medicines
Patient
Communication
Communication
Medicines
use review
action plans
Pharmacist
Clinician
Communication
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Up-to-date data
• The latest figures show that over 4,100
community pharmacies in England
claimed payments for medicines use
reviews in November 2006.
• Over 63,000 of medicines use reviews
have been conducted.
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New Developments
• After a registered pharmacist has
successfully completed an approved
programme of training, they can be a
– Supplementary Prescriber
– Independent Prescriber
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New Developments
• Supplementary prescribing
– Pharmacists are able to prescribe all
medicines under the terms of a patient
specific “Clinical Management Plan” (agreed
with patients & clinicians).
• Independent prescribing
– Pharmacists are able to prescribe any
licensed medicine (except CDs & unlicensed
drugs)
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